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*Required Fields

*Event Name: 

*Contact Name:   
*Mail Box #:  
*Contact Phone Number:  
*Day of Event: mm/dd/yy 
*Event Start Time:  Please indicate a.m. or p.m.
*Event End Time:  Please indicate a.m. or p.m. 

Please select the Location you have requested:
(Note: This request does not reserve a room)


Number of Guests: 

Has facilities booked the location? 


(Please forward BSR copy!)

What is the earliest Media Services can set up?  Please indicate a.m. or p.m.

Describe your event and provide a written sequence of activities:

(Please provide a timetable if applicable. Indicate whether you will have  a speaker, panel discussion, music, projection, video, etc.  Include all equipment needed: microphones, projector, screen,  CD player, and so on. If you're not sure what you need,  call Media Services Help Desk at ext. 3810.)

Are there any special instructions?

This is a preliminary request for Media Services. In no way does this document constitute an agreement; it is to serve only as a first step in  the Media Service request process.

Please submit these requests at least 14 days in advance online by submitting here or by downloading this form and faxing it to (813) 258-7267.